Ultrasound Blocks for the Anterior Abdominal Wall

56 | Ultrasound Blocks for the Anterior Abdominal Wall
This movement will be more evident in the case of an inguinal
hernia. An in-plane needle is inserted. A 10-20 ml of anesthetic is
injected into the inguinal canal just after the needle penetrates
the EOM aponeurosis (Figure 5.3). A “pop” is also felt while the
needle penetrates the aponeurosis. The spread of the anesthetic
will block the gGFN and/or the IIN and IHN. Intracanalar tissues
will be hydro-dissected and may be observed as gelatinous
during surgery at the dissection of the aponeurosis of the EOM
(Figure 5.4).
Figure 5.3 – Left inguinal canal injection. The two images of the
procedure described in Figure 5.2 have been reconstructed.
If a stimulated needle is used, visible testicle retraction and
twitching of the cremaster muscle may be occasionally present.
Since the gGFN runs together with the cremasteric vessels
ensheathed by the cremasteric fascia, needle aspiration is
mandatory (Rab 2001). It is advisable to inject the local
anesthetic just under the aponeurosis of the EOM and not to